The Innovators Award at HCA highlights great thinking across the company as demonstrated in our recent blog post on Project Mary, our Service Excellence winner. Now we move on to the Financial Impact winner: Ethan Elmore, Assistant CNO at Fawcett Memorial Hospital. His award-winning solution, a five-part set of tools to improve throughput, staffing, scheduling and more, is now being tested at the several other facilities.
Improved Throughput, Staffing and Scheduling
Effective bed management, along with precise staffing levels, underpins much of a hospital’s operating efficiency. Now, a new series of staffing tools now in place at Fawcett Memorial Hospital are providing tremendous gains in both areas.
The tools are within a five-part set of interrelated tools developed by Ethan Elmore, Assistant CNO, to help the hospital deal with seasonal fluctuations that caused problems with both staff scheduling and bed management.
“The Florida market is very volatile in terms of seasonal fluctuations,” Elmore says. “The systems we had in place did not work well for us, because we have that volatility. The summer census is significantly lower than the wintertime census, as we get people from colder parts of the country. And it changed from year to hear, so it was very hard to use longer periods of historical data to make a meaningful census projection.”
The algorithm is more dynamic, and uses more recent historical data and trending to predict volume more effectively. Within the inpatient nursing areas it has boosted accuracy for inpatient census projections from the 30 percent to 40 percent range to around 78 percent.
The bed-management component has helped reduce emergency-room diversions by comparing the current bed state with known orders regarding anticipated discharges, allowing for focused discharge efforts in certain departments and units in order to increase availability. In fact, a 90 percent reduction in emergency department diversion hours was achieved during the first year of the bed-management tool’s implantation, Elmore says.
“Implementation of this tool was one of several changes that we made in order to improve bed management processes and metrics. It’s far from a perfect system, but it represents an improvement over our baseline that is fairly substantial,” Elmore says.
The system has five components:
- a predictive staffing tool that uses recent historical data to generate inpatient nursing department census forecasts, resulting in substantially improved baseline accuracy
- a through-put efficiency tool for bed management, which factors in known vs. anticipated discharges and has greatly reduced emergency-department diversion largely by allowing for better focus of discharge efforts in units identified to be bottlenecks
- a 12-hour volume census projection, which has been yielding a 91 percent accuracy rate
- a destaffing tool, which allows for employees to either be sent home or floated to units were more personnel are needed, reducing productive variance
- an infectious diseases cohorting calculator, which allows for patients to be sorted and filtered by infectious disease
In many ways, the whole intent was not to create the individual tools, but one big system that could utilize the data for one purpose,” Elmore says. “But we’re finding that we also can use it to drive many other efficiencies and reduce variations at the same time.”
The predictive staffing tool is now being developed and piloted in several facilities within the West Florida Division.